Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · May 2003
Randomized Controlled Trial Comparative Study Clinical TrialReconstruction of acute anterior cruciate ligament injuries: a prospective, randomised study of 40 patients with 7-year follow-up. No advantage of synthetic augmentation compared to a traditional patellar tendon graft.
In a prospective, randomised study, we compared the results of anterior cruciate ligament reconstruction using the conventional medial patellar tendon strip procedure with the Kennedy ligament augmentation device (LAD) over-the-top augmentation technique. The aim of the study was to see if the addition of this device, with its specific potential complications (infection, synovitis, mechanical failure) and increased costs, gave better functional stability and less donor site morbidity. ⋯ At last follow-up we found no statistical difference in stability tests, functional or activity scores; both groups showed stable improvement concerning scores and arthrometry compared with the preoperative values. No advantages were associated with the use of the Kennedy LAD, and we do not recommend it or a similar device for uncomplicated cases. New augmentation devices are simply launched onto the market, and we recommend caution and thorough evaluation in prospective, randomised studies before they are adopted into use.
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Arch Orthop Trauma Surg · May 2003
Comparative StudyPrimary ACL reconstruction with fresh-frozen patellar versus Achilles tendon allografts.
In recent years, there has been an interest in the use of allografts as an alternative graft for anterior cruciate ligament (ACL) reconstruction to reduce potential donor-site morbidity resulting from the harvest of autogenous tissue. Nevertheless, in the literature, the use of allografts for primary ACL reconstruction is controversial due to a higher failure rate and the potential risk of disease transmission. ⋯ Satisfactory clinical results can be achieved with the use of allografts for primary ACL reconstruction. Comparing Achilles tendon and patellar BTB allografts, the Achilles tendon-bone allograft seems to be advantageous for ACL reconstruction as the failure rate was significantly lower. Nevertheless, the total failure rate appears to be much higher compared with autogenous ACL reconstruction, indicating that the use of an allograft for routine uncomplicated primary ACL reconstruction offers few advantages. Therefore, autograft tissue remains our graft of first choice for this procedure. We advise reserving allografts for revision procedures where suitable autogenous tissues have been previously compromised, where a contraindication for autogenous tissue harvest exists, or for multiple ligament surgery.
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Arch Orthop Trauma Surg · May 2003
Comparative StudyAnatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus.
Since 1989, we have performed ligament reconstruction using the extensor digitorum longus tendon as a pedicle graft for patients with chronic lateral instability of the ankle. ⋯ At final follow-up, pain was present in one joint in the group without chondral injury at the time of reconstruction ( n=6). However, pain was still present at the final follow-up in five of the group with chondral injury ( n=7). Chondral injury incurred during ligament reconstruction may have caused the residual ankle pain even after 7 years of postoperative follow-up. There was a statistically significant relationship between chondral injury and ankle pain at final follow-up.
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Arch Orthop Trauma Surg · May 2003
Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts.
The purpose of the study was the histological examination of tendon-bone healing of hamstring grafts after anterior cruciate ligament (ACL) reconstruction. ⋯ We conclude that the use of hamstring grafts for ACL reconstruction can lead to different histological pattern of tendon-bone healing. Micromotion of the hamstring graft inside the drilled canal can be play a role in tendon-bone healing.
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The epidemiology of posterior cruciate ligament (PCL) injuries has not been well clarified. Isolated and combined PCL injuries are a frequently missed diagnosis. A better understanding of typical injury mechanisms may help in more accurate diagnosis of these injuries. ⋯ In many PCL lesions, initiation of an adequate treatment regimen is delayed despite typical injury mechanisms and symptoms. In the future, a better understanding of the epidemiology of PCL injuries should enable us to diagnose the injury more reliably through a detailed history and a thorough physical and radiographic examination in the acute setting.